Inspection on 03/08/05 for Milton Grange

This inspection was carried out on 3rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milton Grange 13/02/08

Milton Grange 11/01/07

Milton Grange 25/01/06

Milton Grange 08/02/05

Milton Grange 10/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Milton Court Milton Road Eastbourne East Sussex BN21 1SL Lead Inspector Judy Gossedge Unannounced 3 August 2005 14:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Milton Court Address Milton Road Eastbourne East Sussex BN21 1SL 01323 731695 01323 532217 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) East Sussex County Council Mrs Amanda Harris Care Home 10 Category(ies) of Dementia - over 65 years of age (DE(E)) 10 registration, with number of places Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is ten (10). 2. That service users are sixty-five (65) years and over on admission. 3. That service users admitted have a dementia type illness. Date of last inspection 8 February 2005 Brief Description of the Service: Milton Court is run by East Sussex County Council (ESCC), but is operated in partnership with the Health Authority, and provides a base for a range of services and facilities for older people. Milton Court is a purpose built property on two floors, set in its own grounds located approximately half a mile from Eastbourne town centre. There is a ten bedded respite care unit, and a day care service which operates seven days a week staffed by employees of ESCC, and an eighteen bedded health unit staffed by employees from the Health Authority. Service user accommodation within the respite care unit comprises of ten single bedrooms, which all have en-suite facilities providing a toilet, wash hand basin and shower. A separate dining area and two lounges are available for the use of the service users on this unit. There is level access facilitated in the home with the provision of two passenger lifts in the building, one of which is sited within the respite care unit. There is a garden at the rear of the home. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four and a half hours on 3 August 2005. This is the first statutory inspection of this year. A tour of the unit took place including communal areas and service users bedrooms. Rotas and care records were also inspected. Four of the eight service users were spoken within the lounge and four service users were case tracked as part of the inspection process. Due to communication difficulties it was not possible to speak to all service users individually, and so the opportunity was also taken to observe the interaction between staff and service users in the communal areas. The Manager, senior care officer, two care workers, one of whom was a member of the housekeeping team and a relief member of staff were spoken with. One relative a regular visitor was spoken to on the unit and a further two relatives were contacted by telephone after the inspection. One of these relatives and another service user also filled in a comment card each. The CSCI has sent separate correspondence to the Responsible Individual for ESCC to raise concerns at the recruitment processes and lack of evidence of recruitment documentation in place on site for all its registered services. What the service does well: What has improved since the last inspection? Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 6 The recording of the fire drills clearly indicates attendance of staff working on the unit. The testing of the emergency lighting has been maintained to meet the organisation’s requirements. A handyperson has started working at Milton Court and some redecorating has taken place. Some areas still show some evidence of wear and tear and a plan of redecoration has been required. Individual care plans continue to improve in detail. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 4. Although detailed information about Milton Court is available to be viewed prior to any admission to the unit, because of the type of service provided service users have limited choice of placement. Service users are protected by the completion of a written contract/terms and conditions. There are pre-admission procedures in place which need to be followed to ensure that service users care needs can be met at Milton Court. EVIDENCE: A Statement of Purpose is in place. A copy of the Service Users Guide is kept for reference in each service users bedroom. There are forums for service users and their representatives to give their views on the service received, but as yet this feedback has not been collated for prospective service users and their representatives to view for further information. Relatives commented that they had not been aware of how to access the inspection reports on the unit. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 9 ESCC has a written contract to be used between the unit and the service user, and a number of signed contracts were viewed. All service users are assessed by staff from one of ESCC’s Social Services Department’s Assessment Teams and have a Social Care Assessment completed. Staff spoken with confirmed that usually a copy of this or of the latest review of this assessment is sent to the unit for reference. Sample documentation viewed did not evidence this had been received in all cases particularly when an admission has occurred at short notice. Intermediate or rehabilitative care is not provided. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9. Staff are provided with the detailed information they need to ensure that service users’ health, personal and social care needs are met whilst resident on the unit. There are detailed policies and procedures in place to manage medicine which are followed to ensure the protection of service users. EVIDENCE: A sample of individual care plans were viewed. The detail varied but generally has improved since the last inspection being more detailed, and more fully describing service users’ care needs with supporting risk assessments. Detail on the night care plans was limited. Medication policies and procedures are in place and being reviewed. Staff have received external medication training, and also confirmed they are in the process of receiving further medication training arranged by the organisation to meet the requirements of the standard. Staff were observed administrating medication after tea. The storage and a sample of the recording of the administration of medication was also viewed, and was adequate. Staff Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 11 confirmed that a pharmacist now regularly visits, but it was not possible to evidence this. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15. There are frequent and varied opportunities for service users to participate in activities during their stay, so that service users social care needs are fulfilled. There is flexible visiting in the unit and visitors to the unit are welcomed. The catering arrangements are adequate, providing an appropriate choice of meals to meet individual service users needs. EVIDENCE: There are opportunities for service users to participate in a variety of activities on the unit. Some service users also join in the activities at the adjoining day care unit. During the inspection service users watched a video and had the opportunity to participate in a quiz. Relatives commented that there is flexible visiting, that staff were always very welcoming, and they are able to meet with their relative in private. Feedback from two relatives was that ‘Milton Court is wonderful, is a happy place with a nice atmosphere,’ ‘ when my relative returns home they are very happy and full of praise of the care received.’ Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 13 An independent supplier of cook chill foods is used to provide the lunch in the home. There is rotating menu and staff choose a selection of dishes on behalf of the service users a week in advance, and staff spoke of and records viewed confirmed there is a good choice of dishes from which to select from. Tea is made in the home and was salmon and cheese sandwiches, crème caramel and home made cakes. All service users commented that the food was good. One relative commented ‘ the food is well presented and served in a nice dining room in a pleasant atmosphere.’ Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. There is a clear and effective complaints procedure in place, which enables service users and their representatives to raise any concerns that they might have. EVIDENCE: ESCC has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. No complaints have been received since the last inspection. The CSCI have not received any complaints in relation to the service provided at Milton Court. Relatives confirmed that they would feel comfortable raising any concerns with the staff or the Manager. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 25 and 26 The standard of the environment is general is good providing a safe, wellmaintained environment. Décor varies within some areas of the unit showing some areas of wear and tear and does not always provide service users with an attractive and homely place to live. EVIDENCE: The standard of décor on the unit is variable. Some areas have been redecorated since the last inspection. A new handyperson has been appointed to work in the home who is starting a programme of redecoration. There is a passenger lift between the ground, and first floor within the unit. There are ten single bedrooms which all meet the minimum space requirements. Service users are able to control the temperature in their own bedrooms. All bedrooms have an emergency call bell system. Some of the bedrooms seen reflected a range of individual styles and interests. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 16 All bedrooms have en-suite facilities of a toilet, wash hand basin and shower. Additionally there are two assisted bathing facilities on the unit. Hot water in four of the wash hand basins and both baths used by service users were tested, and were close to the recommended safe temperature of 43 C. Records were viewed of the regular testing of the hot water on the unit. This identified an ongoing problem of the temperature in three of the en-suite showers which were recording over 50 C. An Immediate Requirement Form was left ensure that hot water was delivered at close to the recommended safe temperature of 43 C, and to ensure that risk assessments were in place whilst the showers were being repaired. Confirmation needs to be provided that the Water Supply Regulations 1999 are being met. There is a separate dining room to seat all service users, which is attractively furnished and homely with flowers, co-ordinating tablecloths and napkins being used. There is one lounge and a further small room which has recently been attractively redecorated. The unit was clean and free from offensive odours. The recording of routine fire checks were seen and the routine checks of the door closers should be maintained to meet the organisations requirements. An Immediate Requirement Form was left to resolve this issue. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. Adequate staffing levels are maintained to ensure that all the care needs, the health safety and welfare of the service users resident are met. ESCC recruitment policies and procedures need to be followed in order to protect service users. EVIDENCE: The senior care officer was on duty between nine and five, and two care staff were on duty during the waking day. This was adequate to meet the care needs of the service users resident. Staff also spoke of increasing staffing when required to meet individual service users care needs. Three care staff are on duty at night, one working on the unit and two working on the adjoining health care unit. Although Standard 28 was not fully assessed two care staff hold the NVQ Level 2 in care with three care staff working towards this qualification. All recruitment is co-ordinated by the Personnel Section at ESCC’s head office, which the Inspector has visited and viewed sample documentation across the organisations registered services to support the recruitment process in place. Some gaps in the required documentation were found which need to be addressed. In future recruitment documentation will need to be available at the home as part of any inspection completed. The Manager has not been able to confirm that all the staff have a satisfactory Criminal Records Bureau (CRB) check in place. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: No standard in this section were assessed on this occasion. The Manager of Milton Court has worked for East Sussex County Council for many years, has a number of years experience as a senior manager, holds the Certificate in Management and is working towards the Registered Managers Award. Although Standard 38 was not fully assessed on this occasion, training in fire prevention was reviewed following a requirement made at the last inspection. Records detailed some training but not at the required frequency. Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 x 2 2 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard 3 19 19 21 Regulation 14 (1) (b) 23 (2) (d) 23 (4) (c0 (v) 13 (4) (b) Requirement A copy of the initial assessment/review is available for staff to reference. That a copy of the plan of redecoration of the unit is provided. That routine checks of the door closers are maintained to meet the organisations requirments. That a risk assessment is undertaken and recorded in relation to the en-suite showers and water temperatures. That evidence is supplied in relation to adherence to the Water Regulations 1999. This issue is outstandimng since 30.04.05. That evidence is provided to confirm that existing staff have completed a satisfactory Criminal Records Bureau check. This issue is outstanding since 30.04.05. That suitable training in fire prevention is provided. This issue is outstanding since 30.04.05. Timescale for action 30.09.05 30.09.05 3.08.05 3.08.05 5. 25 13 (4) 30.09.05 6. 29 19 (1) (b) (i) 30.09.05 7. 38 23 (4) (d) 30.09.05 Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Milton Court H59-H10 S41305 Milton Court V224987 030805 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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